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Organization
TWIN CITIES MODERN DENTISTRY PLLC
Active
Organization
TWIN CITIES MODERN DENTISTRY PLLC
Active
Other names
twin cities modern dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL RYAN HENRICKSON DDS (DENTIST)
(651) 777-8900
Entity
Organization
Contact information
Practice address
6600 CITY WEST PKWY, SUITE 315, EDEN PRAIRIE, MN 55344-3261
(952) 920-9411
Mailing address
6600 CITY WEST PKWY, SUITE 315, EDEN PRAIRIE, MN 55344-3261
(952) 920-9411
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11920
MN
Other
Enumeration date
06/19/2012
Last updated
07/13/2012
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